Good News, Bad News Seen in APLA Client Survey

Both good news and disturbing news was discovered while analyzing the results of AIDS Project Los Angeles' recent client survey.

Sexual risk behaviors, non-adherence to HIV medications, use of recreational drugs (including tobacco), frequent alcohol use, and poor general health all appear to be tightly related. In addition, a large portion of APLA clients are facing double and triple diagnoses, such as HIV, mental health issues, and addiction. At the same time, a greater prevalence of poverty is being seen, as indicated by significant increases in reliance on public benefits.

The bright news is that a majority of the clients participating in the survey reported feeling better or the same as they did one year ago. One-third of the survey respondents have returned to work, indicating that a substantial proportion of APLA clients are also feeling better and seeking employment opportunities.

High Response Rate

The response rate for this survey was 34.5 percent, higher than any previous client survey response rate. The survey was mailed last fall to 4,666 APLA clients who receive mail from the agency, and 1,610 clients responded.

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When interpreting this report, three limitations should be kept in mind.

The survey findings are based on self-reported data that may be biased toward "socially desirable" responses. In other words, survey participants may have provided information that they consider more acceptable. The fact that the survey was anonymous, however, counteracts that inclination.

Only clients who agreed to receive mail from the agency are included in the study population. As a result, those who do not receive mail from the agency could not be surveyed.

Because Caucasians were significantly over-represented among clients who responded to the survey, the findings may not accurately reflect the population of APLA clients. For the first time, however, female and homeless clients were not under-represented.

Demographic Data

About 90 percent of the clients who responded to the survey were male and 8.4 percent of the clients who responded were female. Transgender clients composed 1.7 percent of respondents.

The majority of clients in each major racial/ethnic category self-identify as gay (83.8 percent of whites, 58.6 percent of blacks, and 72 percent of Latinos). Caucasian clients were more likely to report being gay.

The mean age of the clients who responded to the survey was 42. Compared to the 1997 client survey results, a higher proportion of clients reported having children under the age of 18 living with them (10.2 percent vs. 7.3 percent). Of those surveyed, 3.3 percent said that they had become homeless within the last six months and another 10.3 percent indicated that they are at risk of becoming homeless within the next three months. African-American clients were more likely to report being homeless.

Education, Income and Employment

Even though the majority of clients of all racial/ethnic groups (male and female) reported at least some college education, the largest proportion of clients also reported living on poverty level income (less than $8,400 annually) and 64 percent of the clients relied on public assistance programs as their source of income.

Women were significantly more likely to report incomes at or below the poverty level. Caucasians were more likely to report higher education and higher incomes. Thirty-one percent of the clients reported employment as their source of income and the largest proportion of clients reported being disabled and unable to work (56 percent). Sixty-three percent of APLA clients who responded to the survey reported that they had stopped working because of HIV at some point in their lives. Thirty-three percent of the clients that responded to the survey said that they had also returned to work after leaving it because of HIV.

Among unemployed clients, 42 percent said they are currently looking for work and 80 percent of them said that they needed help to find employment.

Health and HIV Medications

Most clients reported good-to-excellent general health and said that they felt better than or the same as they did one year ago even though the majority have had an AIDS diagnosis.

The proportion of clients who reported being on public health insurance in 1999 is significantly higher compared to 1997 (58 percent vs. 53 percent). Consistent with national statistics, 27.5 percent of APLA clients reported having been hospitalized overnight at least once for an AIDS-related illness in the past year.

Forty-nine percent of survey respondents reported undetectable viral load status (Seventy-six percent of the clients said that they had been tested for viral load status within the last three months (meeting the standard of care); 95 percent had been tested in the previous six months. A majority of the clients (77.8 percent) said that they were bothered by side effects caused by their HIV medications; 14 percent said that the side effects bothered them "terribly."

Non-Adherence to Combination Therapy

The proportion of clients reporting having missed or forgotten to take their medications is not significantly different than it was in 1997.

Compared to 1997, clients are now less likely to take their HIV medications as prescribed by their physicians, accounting for the difference in overall non-adherence. Even though non-adherence rates are consistent with other studies, non-adherence is a serious health issue that can lead to treatment failure, resistance to HIV medications, and rapid disease progression.

This is a challenge and an opportunity for APLA to work with our clients to improve adherence rates through services we provide such as health education programs, treatment advocacy, and case management.

Stay tuned for data from the 1999 client survey on sexual risk behaviors, alcohol, recreational drug and tobacco use and other topics.

Matt Mutchler, Ph.D., AIDS Project Los Angeles' research and evaluation specialist, can be reached at (323) 993-1522 or by e-mail at mmutchler@APLA.org.

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